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PubMed2006

Bodily rights and property rights.

Whereas previous discussions on ownership of biological material have been much informed by the natural rights tradition, insufficient attention has been paid to the strand in liberal political theory represented by Felix Cohen, Tony Honoré, and others, which treats property relations as socially constructed bundles of rights. In accordance with that tradition, we propose that the primary normative issue is what combination of rights a person should have to a particular item of biological material. Whether that bundle qualifies to be called "property" or "ownership" is a secondary, terminological issue. We suggest five principles of bodily rights and show how they can be applied to the construction of ethically appropriate bundles of rights to biological material.

Beneficence↗
PubMed2006

A natural stem cell therapy? How novel findings and biotechnology clarify the ethics of stem cell research.

The natural replacement of damaged cells by stem cells occurs actively and often in adult tissues, especially rapidly dividing cells such as blood cells. An exciting case in Boston, however, posits a kind of natural stem cell therapy provided to a mother by her fetus-long after the fetus is born. Because there is a profound lack of medical intervention, this therapy seems natural enough and is unlikely to be morally suspect. Nevertheless, we feel morally uncertain when we consider giving this type of therapy to patients who would not naturally receive it. Much has been written about the ethics of stem cell research and therapy; this paper will focus on how recent advances in biotechnology and biological understandings of development narrow the debate. Here, the author briefly reviews current stem cell research practices, revisits the natural stem cell therapy case for moral evaluation, and ultimately demonstrates the importance of permissible stem cell research and therapy, even absent an agreement about the definition of when embryonic life begins. Although one promising technology, blighted ovum utilisation, uses fertilised but developmentally bankrupt eggs, it is argued that utilisation of unfertilised eggs to derive totipotent stem cells obviates the moral debate over when life begins. There are two existing technologies that fulfil this criterion: somatic cell nuclear transfer and parthenogenic stem cell derivation. Although these technologies are far from therapeutic, concerns over the morality of embryonic stem cell derivation should not hinder their advancement.

Adult↗
PubMed2006

Body art and medical need.

A company called Biojewelry has proposed to take a sample of bone tissue from a couple and to grow this sample into wedding rings. One of the ethical problems that such a proposal faces is that it implies surgery without medical need. To this end, only couples with a prior need for surgery are being considered. This paper examines the question of whether such a stipulation is necessary. It is suggested that, though medical need and the provision of health and wellbeing is overwhelmingly the warrant for surgical intervention, there is no reason in principle why other, non-medical, projects such as jewelry creation might not also warrant surgical intervention. Implicitly, this line of thought forces us to consider the proper place of surgical intervention--that is, to ask what surgeons are for.

Art↗
PubMed2003

A strategy for controlling the marketing of tobacco products: a regulated market model.

OBJECTIVE: To outline a novel strategy for controlling the tobacco market. ARGUMENTS: More comprehensive controls over the tobacco market are essential and long overdue. Effective controls need to encourage the development of less harmful products; control commercial communication to ensure that potential harms are highlighted relative to any benefits; and provide mechanisms to move consumers away from tobacco use, or at least towards less harmful alternatives. Achieving this by regulating the existing industry is one strategy. This paper puts the case for an alternative: to have marketing controlled by an agency (called here the Tobacco Products Agency, or TPA) which tendered to manufacturers for product and which distributed to retailers in ways that reduce incentives to bend or break the law. The TPA would be backed by legislation that made tobacco a controlled substance with possession sale and use only allowed as permitted by the regulations, which in reality would be only as provided by the TPA. CONCLUSIONS: The overall effect of such a model, which we call a "regulated market model", would be to eliminate most of the incentives and remaining opportunities for commercial promotion of tobacco and to create incentives to encourage the development of less harmful tobacco products. Such a model preserves the competition inherent in a free market, but directs it towards the challenge of reducing the harm from tobacco use.

Harm Reduction↗
PubMed2005

Temperament and character in mood disorders: influence of DRD4, SERTPR, TPH and MAO-A polymorphisms.

Gene variants exert a complex range of effects on human normal and abnormal behavior. We previously reported the effect of gene variants in serotoninergic and dopaminergic pathways, in a range of clinical features in mood disorders, such as symptomathology, periodicity, social adjustment and treatment response. In this paper we hypothesized that the same gene variants could influence temperamental traits in mood disorders patients. We focused on genes of the serotoninergic and dopaminergic systems (dopamine receptor D4 gene, DRD4; serotonin transporter gene, promoter region SERTPR; tryptophan hydroxylase gene, TPH; monoamine oxidase A gene, MAO-A). Two hundred and seven euthymic subjects, affected by major depressive disorder (n=73) and bipolar disorder (n=134) were assessed by the Cloninger's Temperament and Character Inventory (TCI) and typed using PCR-based analyses. Possible stratification factors such as demographic, clinical and other temperamental factors were also taken into account. We observed that homozygosity for the short SERTPR allele was associated with low novelty-seeking scores (p=0.006) and genotypes containing the DRD4 long allele were marginally associated with low harm avoidance (p=0.05). Finally, the long MAO-A allele was associated with decreased persistence scores among females (p=0.006). Our observation of a pattern of influence on temperamental dimension exerted by serotonergic and dopaminergic genes suggests that the contribution of these polymorphisms to the clinical presentation of mood disorders could be mediated by an influence on personality differences.

Adult↗
PubMed2006

Results of two emergency room studies.

The aim of this paper is to examine to what extent cultural differences in male drinking patterns mediate relationships between alcohol and injury in a Polish context. Male patients admitted to emergency rooms located in two culturally different regions were investigated. Data analysis showed significant differences in patients' socio-demographic characteristics, their drinking patterns as well as their annual alcohol consumption. Logistic regression, however, has not confirmed any impact of site, drinking pattern and their interactions on the risk of injury. The risk of injury tended to decline with age, being more than two times lower for men over 50 years old, and was 2.4 times higher for those with an annual consumption of 12+ liters of pure alcohol.

Adult↗
PubMed2007

The role of pharmacies in the care of drug users: what has changed in ten years. The case of a Swiss region.

This article assesses changes over 10 years in the role of pharmacies in the care of drug misusers--needle/syringe provision and methadone treatment supervision--in the Swiss French-speaking Canton of Vaud (636,000 inhabitants, 238 pharmacies). A review of data collected in four surveys (1991, 1994, 1996, 2003) on the provision of sterile material (and methadone treatment supervision in 2003) including all the pharmacists of the Canton of Vaud was conducted, as well as a review of data of the monitoring of needle exchange programmes introduced since 1996 in this canton, and of methadone treatment statistics. In 2003, interviews with pharmacists complemented the survey. Pharmacies play an important role in the 'frontline' services to drug misusers: the provision of needles/syringes to drug users by pharmacies remains important in spite of a decrease in the provision of sterile material by them since the advent of needle exchange programmes, and they are included in the supervision of two thirds of the methadone treatments. However, they do not feel integrated enough in the network of care to drug misusers and ask for more training and better recognition of their role.

Commerce↗
PubMed2006

Innovations: Alcohol & drug abuse: Methadone maintenance in Europe and Hungary: degrees of sociocultural resistance.

Opiate substitution treatment, commonly referred to as maintenance treatment, was introduced in the United States and Europe in the 1960s. This column discusses approaches to opioid maintenance treatment in Europe and focuses on the introduction of methadone maintenance treatment in Hungary. Although persons have received methadone maintenance in Hungary since 1987, consensus guidelines were not adopted until 1998 and were not confirmed by the Hungarian parliament until 2000. Hungary encountered initial difficulties in introducing methadone maintenance, and it is hoped that Hungary's joining the European Union in 2004 will help to make opiate substitution treatment more widely available.

Attitude to Health↗
PubMed2001

Serotonergic involvement in the psychosocial dimension of personality.

Neurotransmitter systems have been associated with aspects of personality and changes in various dimensions have been shown after antidepressant treatment. A reduction in harm avoidance and an increase in self-directedness and cooperativeness, as measured by the Cloninger's Temperament and Character Inventory (TCI), have been reported in psychiatric patients receiving treatment with serotonergic antidepressants. However, some of these changes have been associated with clinical improvement. The present study therefore used a randomized, double-blind, placebo-controlled design to examine the role of the serotonergic system on these personality factors in the normal population. Twenty healthy male volunteers were randomly allocated to either placebo (n = 9) or citalopram treatment (n = 11) for 2 weeks. Baseline depression and anxiety scores were low and did not differ between groups. The TCI was administered pre- and post-treatment. There were no baseline differences on any TCI factor between groups. Citalopram induced a significant increase in self-directedness (p < 0.05) but not cooperativeness or harm avoidance ratings after treatment. Thus, citalopram has effects on personality aspects which appear to be separate from its antidepressant properties.

Adolescent↗
PubMed2006

Users' perceptions of the risks and effects of taking ecstasy (MDMA): a questionnaire study.

This self-report questionnaire study examined ecstasy users' perceptions of the risks associated with their use of ecstasy, their precautions against such risks, and its perceived effects on their lives. Gender differences in these areas were also explored. The sample comprised 328 ecstasy users (139 female, 187 male, one transsexual) with a mean age of 22.5 years (SD = 4.9 years). Questionnaires were completed either in hard copy or through a website concerned with ecstasy use. The results showed that friends were the most common source of information about ecstasy for the sample overall, although females were more likely to utilize this source than males. None of the five categories of perceived risk (e.g. psychiatric, physical) showed a significant gender difference. Males were more likely to take rest breaks whilst females were more likely to limit consumption as a precaution against harm. Three factors emerged from a principal components analysis concerning perceived personal change since initiation of ecstasy use. Factor 1 (23.8% of the variance) concerned negative experiences (e.g. depression). Factor 2 (22.0% of the variance) concerned positive personal qualities (e.g. caring). Factor 3 (10.5% of the variance) concerned selective aspects of functioning (e.g. alertness). The pattern of Factor 1 and Factor 2 scores over time suggested that 6 years since initiation of ecstasy use might be a time when some long-term users may be open to reassess their use of the drug. Broader implications of the findings for health education initiatives aimed at ecstasy users are discussed.

Adolescent↗
PubMedDate not supplied

Failure to adopt beneficial therapies caused by bias in medical evidence evaluation.

BACKGROUND: Although it is known that many evidence-based therapies are underutilized, the causes of the research-practice gap are not well understood. The authors sought to determine if there is a bias in the evaluation of new evidence that leads to low rates of adoption of beneficial therapies compared to abandonment of harmful ones. METHODS: Two case vignettes describing hypothetical clinical trials were administered to 2 independent samples of pulmonary and critical care practitioners. Each vignette was presented in 2 different ways; in one version, the results of the hypothetical trial showed that a treatment was harmful, and in the other version, the same treatment was shown to be beneficial. Prospective respondents from each sample were randomized to receive 1 version of each vignette (intersubject design). The main outcome was respondent's willingness to apply the results of the hypothetical trial to patient care. RESULTS: There were 174 participants for trial 1 and 138 participants for trial 2 (enrollment rates of 44.2% and 41.8%, respectively). For trial 1, respondents were 2.3 times less likely to change clinical practice based on results indicating benefit as opposed to harm (33.3% v. 76.5%; P < 0.0001). Similarly, for trial 2, respondents were 2.57 times less likely to change practice when trial results showed that early use was beneficial as opposed to showing that early use was harmful (37.1% v. 95.3%; P < 0.0001). CONCLUSIONS: When evaluating clinical trials, physicians demonstrate less willingness to adopt beneficial therapies than to abandon harmful ones. This difference may contribute to the research-practice gap.

Attitude of Health Personnel↗
PubMed2002

Minimisation and utilisation of waste mineral sludge from sodium perborate production.

Various approaches to waste minimisation, waste treatment and recycling or safe disposal of the waste mineral sludge from sodium perborate production are presented and critically discussed. Some most promising actions for waste (or its harmful potential) reduction on the production level are identified. These include: a) use of better raw materials (richer boron ore), b) improvement of the ore leaching process, and c) intensification of sludge washing and dewatering. These source reduction measures have already resulted in 50% reduction of boron content in the sludge. Utilisation of the raw or treated (e.g. dried, compacted) waste sludge could be found in agriculture, civil engineering and construction material production. Agricultural use (as a lime substitute) is based on favourable content of calcium-magnesium minerals and alkali pH value of the sludge, and simultaneous absence of heavy metals. Application in civil engineering (as an aggregate) is possible after calcination, which is costly, or as a cement kiln additive. Stabilisation of sludge before disposal, when no utilisation is available, is possible by small addition of commercial binders (e.g. Portland cement) or larger amounts of pozzolanic wastes (e.g. coal fly ash).

Agriculture↗
PubMed2006

Advocating for a harm-minimization approach to drug education in Australian schools.

The concept of using a harm-minimization approach to drug education in Australian schools has existed in both national and state government policy documents for over two decades. However, this approach appears to be ineffectively and inconsistently incorporated within the curriculum. Harm minimization emphasizes strategies that reduce the harms associated with drug use and prevent related health and social problems. Traditional drug education programs that promote abstinence as the only option may not be realistic and appear to have had limited success. School nurses in the state of Victoria have a significant role in improving both the understanding and adoption of this approach through advocacy, education, and their understanding of evidence-based practice.

Adolescent↗
PubMed2002

Development of a "survival" guide for substance users in Harlem, New York City.

The community advisory board (CAB) of the Harlem Urban Research Center, which includes community service providers, Department of Health workers, and academics, identified substance users' health as an action priority. The CAB initiated the development of a wellness guide to provide informational support for substance users to improve access to community services. Focus groups of current and former users engaged substance users in the guide development process and determined the guide's content and "look." Focus group participants recommended calling this a "survival" guide. The guide will include three sections: (a) health information and how to navigate the system to obtain services, (b) a reference list of community services, and (c) relevant "hotline" numbers. The design will incorporate local street art. Substance users continue to shape the guide through ongoing art workshops. Dissemination and evaluation of the guide will continue to involve substance users, community service providers, and academics.

Community Health Services↗